Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Faculty of Medical and Health Sciences, Centre for Medical and Health Science Education, University of Auckland, Auckland, New Zealand.
World J Urol. 2024 Oct 3;42(1):558. doi: 10.1007/s00345-024-05260-2.
To assess the impact of differences in Prostate-Specific Antigen (PSA) testing rates on prostate cancer (PCa) diagnosis and PCa-specific mortality among Māori men in a New Zealand (NZ) population.
Māori men aged 40 years or older, without a history of PCa, with a PSA test between 2006 and 2018 were included. The cohort was divided into two groups; the "screened group" (ScG) consisting of men who had at least one PSA test every four years or less, and the "non-screened group" (non-SG). We measured the rate of cancer diagnoses and used competing risk analysis to assess survival.
The study cohort included 63,939 Māori men, with 37,048 (58%) in the ScG. PCa was more frequently diagnosed in the ScG (3.7% vs. 3.0%, P < 0.001). A higher proportion of high-grade cancers were found in the non-SG (32.7% vs. 25.6%, P = 0.001). The 10-year cancer-specific survival was significantly higher in the ScG (99.4% vs. 98.5%, P < 0.001). In a multivariable risk model, PSA testing frequency was an independent predictor of PCa mortality. (HR 2.43, [95% CI 1.97-3.01], P < 0.001).
In a cohort of only Māori men, lower PSA testing rates were associated with a higher risk of PCa-related death. Therefore, regular PSA testing for Māori could improve cancer-specific survival among Māori men. Regular PSA testing should be considered a priority area for improving PCa survival in this population.
评估前列腺特异性抗原（PSA）检测率的差异对新西兰（NZ）毛利人群前列腺癌（PCa）诊断和 PCa 特异性死亡率的影响。
纳入年龄在 40 岁或以上、无 PCa 病史、2006 年至 2018 年间进行过 PSA 检测的毛利男性。该队列分为两组；“筛查组”（ScG）包括至少每四年或更短时间进行一次 PSA 检测的男性，以及“非筛查组”（non-SG）。我们测量了癌症诊断率，并使用竞争风险分析评估了生存率。
研究队列包括 63939 名毛利男性，其中 ScG 组有 37048 名（58%）。ScG 中 PCa 的诊断更为常见（3.7%比 3.0%，P<0.001）。non-SG 中发现了更高比例的高级别癌症（32.7%比 25.6%，P=0.001）。ScG 中 10 年癌症特异性生存率显著更高（99.4%比 98.5%，P<0.001）。在多变量风险模型中，PSA 检测频率是 PCa 死亡率的独立预测因素。（HR 2.43，[95%CI 1.97-3.01]，P<0.001）。
在仅由毛利男性组成的队列中，较低的 PSA 检测率与 PCa 相关死亡风险增加相关。因此，对毛利人进行常规 PSA 检测可以提高毛利男性的癌症特异性生存率。定期进行 PSA 检测应被视为改善该人群 PCa 生存率的优先领域。
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